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Permit CITY TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: PLM2006 -00496 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/23/2006 PARCEL: 1S134DB-08000 SITE ADDRESS: 11158 SW 113TH TERR ZONING: R -4.5 SUBDIVISION: STONECHASE LOT: 004 JURISDICTION: TIG Project Description: Residential backflow for irrigation. CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1 OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES GERRITZ BIGGI CUSTOM HOMES Description Date Amount 9550 SW BEAVERTON HILLSDALE HW BEAVERTON, OR 97005 [PLUMB] Permit Fee 101231200E $36.25 [TAX] 8% State Surcharl 101231200E $2.90 Phone : 503 619 - 4668 Total $39.15 Contractor: MARK BROWN LANDSCAPING PO BOX 744 REQUIRED ITEMS AND REPORTS VANCOUVER, WA 98666 -0744 Contact # : FAX 360 - 993 -5993 PRI 503- 234 -2667 Reg #: LIC 5192 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 5(13-246-6699 C Issued iy: j\ I �t Permittee Signature: ...P Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. m5To2oo oa yf7 Plumbing Permit Application FOR of l l('I: l SE: O\l.\ City of Tigard Received ) / G M , P /L t t l l" � " r Permit No.: 9e / 7 7 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review / Other Permit No.: Phone: 503.639.4171 Fax: 503.598.1960 /nro kiµ ., Date/By: Hour Inspection Line: 503.639.4175 ■ i . •I � Date Ready/By: )uns See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: L; Supplemental Information • TYPE OF WORK FEE* SCHEDULE [E New construction ❑ Demolition For special information use checklist. Description I Qty. I Ea. 1 Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 249.20 i- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi - family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: / / 008 A.,c) .f/ -;� - Catch basin or area drain 16.60 City/State /ZIP: rj<n_t/ O/ g'�2-� y Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: ✓ I Project name: l i e , (1 h ., i Footing drain (no. linear ft.: ) Page 2 �,/ / Manufactured home utilities 110.00 Cross street/directions to job site: / >� DC( � t ¢//V,../.5/- Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: • /)e_ e h ei I Lot no.: Water service (no. linear ft.: ) Page 2 Fixture or item Tax map /parcel no.: Absorption valve 16.60 / DESCRIPTION OF WORK Backflow preventer f Page 2 14 0 D Z l l . h e - - / 4 . Qt k low Pr?Ue Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 ❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60 ti � Q �J �� /), Ejectors/sump 16.60 Name: < ez `D/ r i L t.s.ki lkine5 LLB- Expansion tank 16.60 Address: ) `,d tier, n . l /, I Fixture/sewer cap 16.60 City/State /ZIP: ` 4r 7�e R/( 9 s y Floor drain/floor sink/hub 16.60 Phone: (S (9 /- tC Fax:�(� ) 56, _ illy` 9� Garbage disposal 16.60 1:1 APPLICANT APPLICANT ❑ CONTACT PERSON Hose bib 16.60 r �J� / Ice maker 16.60 Business name: nayt VJ� ��(Si� A "5 l / L 9Q� Interceptor /grease trap 16.60 • Contact name: A n r�iCl '°�'1{ Medical gas (value: $ ) Page 2 Address: 455 ea ve //5 �i y Primer 16.60 City/State /ZIP A n 19 ' 795 / Roof (commercial) 16.60 Phone:60 / q 1 6 l� 9 Fax: : (6�) lj - -�o�1 Sink/basin drain / lavatory 16.60 Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 n CONTRAgO/t / 4 Water closet 16.60 Business name: m tt � / , Oa) l tahtS mp Water heater 16.60 Address: Po. 'P� o 7 L L Other: City/State /ZIP: r //Q / / ,(/ Q -7 �� _ Subtotal W V` `� "' _ ' "- G�. �� �� ; Q / Minimum permit fee: $72.50 sg e, Phone:•5�� 64,7 Fax:3 ( gQ3._5 - 4q 3 _ _ Residentialbackflowminimumpermitfee: $36.25 tY`� CCB Lic.: , Plumbing Lic. no.: 5 i g J Plan review (25% of permit fee) � Authorized signature: / / , O� State surcharge (8% of permit fee) _ , ' ' /%" TOTAL PERMIT FEE "5.,-7, "5.,-7, / ` 7 Print name: mu y/ _ 3 ,,, w ' r 1 Date:/Q a2© -V This permit application expires if a permit is not obtained within [ �O l 180 days after it has been accepted as complete. *Fee methodoloev set by Tri- County Buildine Industry Service Board CITY OF TIGARD RA 2400(.# vd Ilf Co BUILDING DIVISION PERMIT #: 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639 -4171 ipauioloili11 Inspection Requests (24 Hrs.): (503) 639 -4175 - INSPECTION WORKSHEET FOR DATE: //3/ 0, TIME: PAGE: SITE ADDRESS: 1 1 1 6<c- l 13 T i - 6-<0,... CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: �� OWNER: ■7� j /� " , PHONE #1 6 2e b S" 2 J CONTRACTOR: n1\6.4 IS PHONE # . 3 , 4m3 Inspection Request Scheduled For: Date: Pour Time: Code # Inspection Description Confirm # Contact # Message #116 v-,4&k - %I ft.) 1..;.e.i Corrections /Co ents /Instructions: I in rt 1.4( ( ) 6' ( ) C.- J 4..... -d CANn 4 %-11#.4J -1-v■A bc,,J.t. — ke.,0 -- Redo 1 tie- was 4-es r e..). 4c2_ ( v1 4/2 4 /0 C A S 5 4 U , A . i /z10 4 «. -. 0.5k1P1 u,lso cIitA%w 4 1,. .c. C-o.ec-Y 0 `VIA . Q° r i W4 S cl. to w:, 4 A-o .e C. - iik< T; egg--1 • c . ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: / (A ` a V Date: .7 /3 AV Phone #: (503) 718 - L-t/ CITY OF TIG,ARD P Oay'j BUILDING DIVISION PERMIT #: 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: i Phone: (503) 639 -4171 fidtpiypllii Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 7/24 TIME: PAGE: SITE ADDRESS: 1116 1 1 1 CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: PHONE #: CONTRACTOR: aO PHONE #:360,. ci43.4"tri 3 Inspection Request Scheduled For: Date: Pour Time: Code # Inspection Description Confirm # Contact # Message 7 fiq SA dt 1 isW Corrections /Comments /Instructions: 1 Ar tA".$ (41 oR N7 q/% %t /0 g (4. ) 5 t„,.-,,, s T 6,,„:„.,„_,9 4.-e-e., ircdr 1 4 ,AiLy . v,, , ,:3 - 4 - 7 c__,._45 u t.,,• t,. o - � - L k . s =__ ---ser.A., ( “----kg.-_- i--.i 0 C__.r."._ Q-A-v "L e'c LV K NI Ce--z< ' cY ' . -- C36 -- -A ES' . .i.eXtAii . ❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS 6S-FAIL _ CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED Q � A Inspector: Date: �/ v( b O Phone #: (503) 718- v4